Provider Demographics
NPI:1417085804
Name:INDIANOLA COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:INDIANOLA COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JERMELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-961-9500
Mailing Address - Street 1:1304 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:51025
Mailing Address - Country:US
Mailing Address - Phone:515-961-9500
Mailing Address - Fax:515-961-9505
Practice Address - Street 1:1304 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2898
Practice Address - Country:US
Practice Address - Phone:515-961-9500
Practice Address - Fax:515-961-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0482778Medicaid